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NPI Code Detail

MEDICARE: MRS. COLLEEN S. MCCLAIN PT

MEDICARE: MRS. COLLEEN S. MCCLAIN PT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical Therapist70013189IL

General Provider Information

NPI Number : 1710050877
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. COLLEEN S. MCCLAIN PT
Provider Business Mailing Address
First Line : 2859 N BURLING ST # 1-C
Second Line :
City : CHICAGO
State : IL
Zip : 60657-5215
Country : US
Telephone Number : 312-238-6918
Fax Number :
Provider Business Practice Location Address
First Line : 5548 S HYDE PARK BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60637-1909
Country : US
Telephone Number : 312-238-6918
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/16/2006
Last Update Date : 07/08/2007

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